skip to main content

Gestational diabetes — MCCQE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

HardPregnancyGestational diabetesMCCQE Part 1

A patient with gestational diabetes uses bedtime NPH insulin. Fasting glucose remains 5.8–6.2 mmol/L, while every post-meal value is within target and there is no nocturnal hypoglycaemia. Which adjustment best matches the glucose pattern?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Titrate the bedtime NPH dose and continue overnight hypoglycaemia surveillance

Add rapid-acting insulin before breakfast and leave bedtime NPH unchanged: Breakfast insulin targets the post-breakfast excursion, which is already controlled. Add rapid-acting insulin before every meal and leave bedtime NPH unchanged: Prandial insulin at every meal adds unnecessary hypoglycaemia risk when post-meal values are at target. Move the entire NPH dose to breakfast and stop evening insulin: Moving all basal insulin to breakfast would reduce overnight effect and may worsen the fasting pattern. Stop insulin because normal post-meal values exclude clinically important hyperglycaemia: Normal postprandial values do not negate persistent fasting hyperglycaemia or its pregnancy risks. Titrate the bedtime NPH dose and continue overnight hypoglycaemia surveillance: Bedtime NPH primarily modifies overnight hepatic glucose output and should be titrated with attention to nocturnal hypoglycaemia.

Reference: https://guidelines.diabetes.ca/cpg/chapter36